Tundra 2025 Student Registration Form

Tundra 2025 Registration Form

Camper Information/Permission and Release Form
Group Name: Lincroft Bible Church

Group Leader's Name: Steven Espaillat and/or Chris Pascarella
Personal Information
Name:*

First NameLast Name
Date of Birth:*

MonthDayYear
Date
Grade:*
Choose One:*

MaleFemale
Camper's Email
example@example.com
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Parent/Guardian #1*

First NameLast Name
Contact Number*
Please enter a valid phone number.
The above number is:*

HomeCell
Parent/Guardian #1 Email:*
example@example.com
Parent/Guardian #2

First NameLast Name
Contact Number
Please enter a valid phone number.
The above number is:

HomeCell
Parent/Guardian #2 Email:
example@example.com
Emergency Contact (if parents are not available):*

First NameLast Name
Relationship:*
Phone Number*
Please enter a valid phone number.

PERMISSION STATEMENT
I understand and certify that my child’s participation in Tuscarora Inn and Conference Center’s TUNDRA is completely voluntary and I have familiarized myself with the camp’s program and activities in which my child will be participating.

I acknowledge that although Tuscarora Inn and Conference Center has taken safety measures to minimize risk, no guarantee can be made that the participants, equipment, premises and/or activities will be free of hazards, accidents and/or injuries. I further recognize and have instructed my child in the importance of knowing and abiding by the Tuscarora Inn and Conference Center rules, regulations and procedures for the safety of camp participants. In an emergency, I hereby give permission to the physician or hospital selected by Tuscarora Inn and Conference Center to hospitalize, secure the proper diagnostic, laboratory and radiological procedures, and to order any necessary medications, injections, anesthesia, intravenous therapy or surgery for my child as named above. By signing, I also grant permission for any photos taken of the child named above to be used in Tuscarora Inn and Conference Center promotional materials.
To be signed by parent/guardian for those under 18*

Clear
Date*

MonthDayYear
Date

LBC Permission
I give permission to Lincroft Bible Church for my child to attend the LBC Winter Retreat at Tuscarora Inn and Conference Center.

I give permission for this student to engage in all activities associated with this event, including traveling to and from the event. I give permission for the youth leaders of Lincroft Bible Church to provide ongoing healthcare and to select local medical personnel to order tests and treatment as needed for the student listed above.
Signature*

Clear
Date*

MonthDayYear
Date

My Products

Winter Retreat Registration

$160.00

Total

$0.00

Tundra 2025 Registration Form